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Cited by 759Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseGun Ownership and Violence Research

Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew

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Bostwick, J. Michael, Pabbati, Chaitanya, Geske, Jennifer R., McKean, Alastair J.·2016·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2016.15070854PMC PMC5510596
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Abstract

OBJECTIVE: While suicide attempt history is considered to robustly predict completed suicide, previous studies have limited generalizability because of using convenience samples of specific methods/treatment settings, disregarding previous attempts, or overlooking first-attempt deaths. Eliminating these biases should more accurately estimate suicide prevalence in attempters. METHOD: This observational retrospective-prospective cohort study using the Rochester Epidemiology Project identified 1,490 (males, N=555; females, N=935) Olmsted County residents making index suicide attempts (first lifetime attempts reaching medical attention) between January 1, 1986, and December 31, 2007. The National Death Index identified suicides between enrollment and December 31, 2010 (follow-up 3-25 years). Medical records were queried for sex, age, method, and follow-up care for index attempt survivors. Coroner records yielded data on index attempt deaths. RESULTS: During the study period, 81/1,490 enrollees (5.4%) died by suicide. Of the 81, 48 (59.3%) perished on index attempt; 27 of the surviving 33 index attempt survivors (81.8%) killed themselves within a year. Males were disproportionately represented: 62/81 (11.2% of men, 76.5% of suicides) compared with 19/81 (2.0% of women, 23.5% of suicides). Of dead index attempters, 72.9% used guns, yielding an odds ratio for gunshot death, compared with all other methods, of 140 (95% CI=60-325). When adjusted for covariates, survivors given follow-up psychiatric appointments had significantly lower likelihood of subsequent suicide (odds ratio=0.212, 95% CI=0.089-0.507). CONCLUSIONS: At 5.4%, completed suicide prevalence in this community cohort of suicide attempters was almost 59% higher than previously reported. An innovative aspect of this study explains the discrepancy: by including index attempt deaths-approximately 60% of total suicides-suicide prevalence more than doubled. We contend that counting both index and subsequent attempt deaths more accurately reflects prevalence. Our findings support suicide attempt as an even more lethal risk factor for completed suicide than previously thought. Research should focus on identifying risk factors for populations vulnerable to making first attempts and target risk reduction in those groups.

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  • The greatest risk of suicidal behavior is after discharge from the emergency room or hospital inpatient units.

    “The greatest risk of suicidal behavior is after discharge from the emergency room (ER) or hospital inpatient units.(110–112)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [112]

    The Results (page not supplied) report that 27 of 33 survivors who later died by suicide did so within a year of their initial attempt. The Conclusions also discuss protective follow-up appointments scheduled at discharge from an emergency department or inpatient service. The paper does not establish that risk of suicidal behavior is greatest immediately after discharge; its timing finding concerns deaths after an initial attempt, not time since discharge or all suicidal behavior. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • The greatest risk for repeating a suicide attempt is in the month following an index attempt, particularly after discharge of a psychiatric patient from an emergency department or inpatient hospital unit.

    “The greatest risk for repeating a suicide attempt is in the month following an index attempt, and particularly after discharge of a psychiatric patient from an emergency department or inpatient hospital unit.(110–112)”

    From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [112]

    The Results report that most subsequent fatal attempts occurred within a year of the index attempt, and the Conclusions discuss psychiatric follow-up after discharge from an emergency department or inpatient service. The paper does not establish that repeat attempts are most likely in the first month or particularly likely after discharge; its Discussion says the study did not identify the number and frequency of subsequent attempts among survivors. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 1

  1. [17]17. Lönnqvist J, Ostamo A: Suicide following the first suicide attempt: a five year follow-up using survival analysis. Psychiatr Fenn 1991; 22: 171-179

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Authors
Bostwick, J. M., Pabbati, C., Geske, J. R., & McKean, A. J.
Affiliations
Mayo Clinic (US)
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2016-11-01
Volume
173
Issue
11
Pages
1094-1100
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2016.15070854
PMC
PMC5510596
OpenAlex
W2507442464
Cited by
759
References
22
Citations by year
2026: 51 · 2025: 94 · 2024: 99 · 2023: 95 · 2022: 96 · 2021: 90 · 2020: 67 · 2019: 60 · 2018: 85 · 2017: 19 · 2016: 1
FWCI
73.62
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Aging (R01AG034676)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Health › Gun Ownership and Violence Research
Keywords
suicide attempts, suicide mortality, suicide risk factors, suicide attempt survivors, suicide prevalence, firearm suicide, sex differences in suicide, Rochester Epidemiology Project, Olmsted County
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Child, Female, Humans, Male, Middle Aged, Minnesota, Prospective Studies, Retrospective Studies, Risk Factors, Suicide, Suicide, Attempted, Kaplan-Meier Estimate, Young Adult

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